Definition
Hepatocellular carcinoma (HCC) is the most common primary liver cancer, arising from hepatocytes. It is more common in individuals with chronic liver disease, such as cirrhosis and chronic hepatitis.

Pathogenesis
HCC develops from long-term liver damage caused by:

  • Viral infections: Chronic hepatitis B and C.
  • Alcoholic liver disease: Chronic alcohol consumption is a major risk factor.
  • Non-alcoholic steatohepatitis (NASH): Associated with obesity and diabetes.
  • Toxins: Such as aflatoxins from contaminated food.

Chronic inflammation and fibrosis lead to cellular mutations, causing malignancy.

Diagnosis
Diagnosis is based on:

  • Imaging: Ultrasound, CT, or MRI with contrast to reveal HCC characteristics.
  • Laboratory markers: Elevated alpha-fetoprotein (AFP) levels.
  • Liver biopsy: Used for unclear findings.

Treatment
Treatment depends on cancer stage and liver function:

  • Surgical resection: For patients with good liver function and localized disease.
  • Liver transplantation: Offers a cure for suitable candidates with cirrhosis and limited cancer.
  • Interventional therapies: Such as transarterial chemoembolization (TACE) for unresectable cases.
  • Targeted and immunotherapies: Drugs like sorafenib and atezolizumab for advanced stages.

Prevention
Prevention includes vaccination for hepatitis B, treatment of chronic hepatitis B and C, avoiding excessive alcohol consumption, and managing risk factors for NASH. Regular ultrasound and AFP monitoring are recommended for cirrhosis or chronic liver disease patients.

Early diagnosis and individualized therapy are critical for patient survival.

Key figures: In cirrhosis, surveillance is performed with liver ultrasound every six months. Diagnosis can be made on multiphase imaging alone when the characteristic contrast pattern is present, without biopsy.

In most cases the tumour arises in a cirrhotic liver, commonly caused by chronic viral hepatitis or by fatty liver disease.

Frequently asked questions

Who should be screened?

Mainly patients with cirrhosis of any cause, and selected patients with chronic hepatitis B even without cirrhosis. Screening is performed with liver ultrasound every 6 months. Because the tumour is silent in its early stages, this scheduled surveillance is what allows detection while curative treatment is still possible.

Is a biopsy needed for diagnosis?

Often not, which is unusual among solid tumours. In a patient with cirrhosis, when multiphase CT or MRI shows the characteristic pattern of intense arterial enhancement followed by washout, the diagnosis can be made on imaging alone. Biopsy is reserved for atypical findings or for tumours arising in a non-cirrhotic liver.

Is alpha fetoprotein reliable?

Not on its own. It can be normal in a patient who has a tumour and raised in active liver disease without cancer. It is used as an adjunct alongside imaging, never as a standalone diagnostic or screening tool.

Sources


Content last updated: September 2026 (14/09/2026).